Broomberg J, Price M R
Department of Community Health, University of the Witwatersrand, Johannesburg.
S Afr Med J. 1990 Aug 4;78(3):133-6.
This study reports the results of a retrospective analysis of the use of a range of inpatient and outpatient services by the members of a health maintenance organisation (HMO), in which most providers are salaried, and by the members of three medical aid schemes in which providers are paid on a fee-for-services basis. The analysis shows significantly higher utilisation of all services by medical aid scheme members than by HMO members. Medical aid scheme patients saw all doctors 33% more often than their HMO counterparts. For general practitioners and specialists specifically, the differences were 36% and 18% respectively. Doctors looking after medical aid scheme beneficiaries ordered 133% more radiological procedures and 14% more pathological investigations than did those caring for HMO beneficiaries. Hospital utilisation was also higher for medical aid patients. While quality of care is difficult to measure, there are no reasons to suspect that significant differences in quality exist between the two systems described here. One factor that may contribute to the higher utilisation rates in the medical aid group is the higher average income of this group. However, these results also demonstrate that providers working in the fee-for-service system are likely to increase the supply of services compared with providers who are salaried. The different methods of reimbursement are compounded by the different practice settings in which these groups of doctors work; the HMO generates an awareness of costs that is absent from the independent practice, 'third-party payment' system of the medical aid schemes.(ABSTRACT TRUNCATED AT 250 WORDS)
本研究报告了一项回顾性分析的结果，该分析涉及一个健康维护组织（HMO）的成员对一系列住院和门诊服务的使用情况（该组织的大多数提供者为受薪制），以及三个医疗救助计划的成员对这些服务的使用情况（这些计划的提供者按服务收费）。分析表明，医疗救助计划成员对所有服务的利用率显著高于HMO成员。医疗救助计划的患者看所有医生的频率比HMO的患者高33%。具体到全科医生和专科医生，差异分别为36%和18%。照顾医疗救助计划受益人的医生所安排的放射检查比照顾HMO受益人的医生多133%，病理检查多14%。医疗救助计划患者的住院利用率也更高。虽然医疗质量难以衡量，但没有理由怀疑这里描述的两种体系在质量上存在显著差异。医疗救助群体利用率较高的一个因素可能是该群体的平均收入较高。然而，这些结果也表明，与受薪提供者相比，按服务收费体系中的提供者可能会增加服务供给。不同的报销方式因这些医生群体工作的不同执业环境而更加复杂；HMO会产生一种成本意识，而医疗救助计划的独立执业“第三方支付”体系则不存在这种意识。（摘要截选至250词）
